Provider Demographics
NPI:1396961991
Name:UDOH-AFAHA, EDEM TOM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EDEM
Middle Name:TOM
Last Name:UDOH-AFAHA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21537
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-1537
Mailing Address - Country:US
Mailing Address - Phone:661-599-1767
Mailing Address - Fax:559-366-4570
Practice Address - Street 1:781 SEQUOIA AVE STE 2
Practice Address - Street 2:LINDSAY PHARMACY
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-1448
Practice Address - Country:US
Practice Address - Phone:559-562-7979
Practice Address - Fax:559-366-4570
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 39368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 51148OtherCALIFORNIA BOARD OF PHARMACY